Laserfiche WebLink
r r ., "r r{ � ^4 7m 'S'jwtitN+arr.ww.r.aa"w. •v.-v s. .r,yw.r+.r.s�-.+.nom u......rwawnnrr - <br /> DOUL0S ENVIRONMENTAL COMPANY _ SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: „�4.&,_, Project No <br /> e . . <br /> / n Rd Well Designation: W r <br /> M Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? � KE S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? If no, see remarks <br /> N <br /> Height of well casing riser (in inches) : 1 <br /> Well cover type: 8" UV12" UV 12" EMCO 8" BK <br /> 1211 BK 12" DWP 1211 CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent C Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with; Disposable bailer:,�� Teflon bailer: <br /> Well Diameter: 211 - 4" 6" 81' <br /> Purge Vol . Multiplier: 0, 16 0. 65 1. 47 2 . 61 gal/ft <br /> riInitial Measurement <br /> Time : Time: 1 d t Calculated purge: / D <br /> . q <br /> Depth of well , Depth to water. C� [ Actual purge , / 7 <br /> Depth to water: <br /> T Start purge: ' Y O Sampling time; 5 <br /> Time TemR. E. C. pH Turbidity Volume <br /> 4"o . 7 --- <br /> �•• 6 Oct <br />` 1 -7 --�-- <br /> o � <br /> Sample appearance:ppearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced 1te7 <br /> 21' Locking Cap: Lock #3753 ; 7/32 Allenhead: <br /> 4" Locking Cap: Lock--Dolphin; 9/16 Bolt. <br /> 6{{ Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br />` Signature : �" <br />